Cargando…

MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience

Background: There is a long history, beginning in the 1940s, of ablative neurosurgery on the pallidal efferent fibers to treat patients suffering from Parkinson's disease (PD). Since the early 1990s, we undertook a re-actualization of the approach to the subthalamic region, and proposed, on a h...

Descripción completa

Detalles Bibliográficos
Autores principales: Gallay, Marc N., Moser, David, Rossi, Franziska, Magara, Anouk E., Strasser, Maja, Bühler, Robert, Kowalski, Milek, Pourtehrani, Payam, Dragalina, Christian, Federau, Christian, Jeanmonod, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971056/
https://www.ncbi.nlm.nih.gov/pubmed/31993437
http://dx.doi.org/10.3389/fsurg.2019.00076
_version_ 1783489639288406016
author Gallay, Marc N.
Moser, David
Rossi, Franziska
Magara, Anouk E.
Strasser, Maja
Bühler, Robert
Kowalski, Milek
Pourtehrani, Payam
Dragalina, Christian
Federau, Christian
Jeanmonod, Daniel
author_facet Gallay, Marc N.
Moser, David
Rossi, Franziska
Magara, Anouk E.
Strasser, Maja
Bühler, Robert
Kowalski, Milek
Pourtehrani, Payam
Dragalina, Christian
Federau, Christian
Jeanmonod, Daniel
author_sort Gallay, Marc N.
collection PubMed
description Background: There is a long history, beginning in the 1940s, of ablative neurosurgery on the pallidal efferent fibers to treat patients suffering from Parkinson's disease (PD). Since the early 1990s, we undertook a re-actualization of the approach to the subthalamic region, and proposed, on a histological basis, to target specifically the pallidothalamic tract at the level of Forel's field H1. This intervention, the pallidothalamic tractotomy (PTT), has been performed since 2011 using the MR-guided focused ultrasound (MRgFUS) technique. A reappraisal of the histology of the pallidothalamic tract was combined recently with an optimization of our lesioning strategy using thermal dose control. Objective: This study was aimed at demonstrating the efficacy and risk profile of MRgFUS PTT against chronic therapy-resistant PD. Methods: This consecutive case series reflects our current treatment routine and was collected between 2017 and 2018. Fifty-two interventions in 47 patients were included. Fifteen patients received bilateral PTT. The median follow-up was 12 months. Results: The Unified Parkinson's Disease Rating Scale (UPDRS) off-medication postoperative score was compared to the baseline on-medication score and revealed percentage reductions of the mean of 84% for tremor, 70% for rigidity, and 73% for distal hypobradykinesia, all values given for the treated side. Axial items (for voice, trunk and gait) were not significantly improved. PTT achieved 100% suppression of on-medication dyskinesias as well as reduction in pain (p < 0.001), dystonia (p < 0.001) and REM sleep disorders (p < 0.01). Reduction of the mean L-Dopa intake was 55%. Patients reported an 88% mean tremor relief and 82% mean global symptom relief on the operated side and 69% mean global symptom improvement for the whole body. There was no significant change of cognitive functions. The small group of bilateral PTTs at 1 year follow-up shows similar results as compared to unilateral PTTs but does not allow to draw firm conclusions at this point. Conclusion: MRgFUS PTT was shown to be a safe and effective intervention for PD patients, addressing all symptoms, with varying effectiveness. We discuss the need to integrate the preoperative state of the thalamocortical network as well as the psycho-emotional dimension.
format Online
Article
Text
id pubmed-6971056
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-69710562020-01-28 MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience Gallay, Marc N. Moser, David Rossi, Franziska Magara, Anouk E. Strasser, Maja Bühler, Robert Kowalski, Milek Pourtehrani, Payam Dragalina, Christian Federau, Christian Jeanmonod, Daniel Front Surg Surgery Background: There is a long history, beginning in the 1940s, of ablative neurosurgery on the pallidal efferent fibers to treat patients suffering from Parkinson's disease (PD). Since the early 1990s, we undertook a re-actualization of the approach to the subthalamic region, and proposed, on a histological basis, to target specifically the pallidothalamic tract at the level of Forel's field H1. This intervention, the pallidothalamic tractotomy (PTT), has been performed since 2011 using the MR-guided focused ultrasound (MRgFUS) technique. A reappraisal of the histology of the pallidothalamic tract was combined recently with an optimization of our lesioning strategy using thermal dose control. Objective: This study was aimed at demonstrating the efficacy and risk profile of MRgFUS PTT against chronic therapy-resistant PD. Methods: This consecutive case series reflects our current treatment routine and was collected between 2017 and 2018. Fifty-two interventions in 47 patients were included. Fifteen patients received bilateral PTT. The median follow-up was 12 months. Results: The Unified Parkinson's Disease Rating Scale (UPDRS) off-medication postoperative score was compared to the baseline on-medication score and revealed percentage reductions of the mean of 84% for tremor, 70% for rigidity, and 73% for distal hypobradykinesia, all values given for the treated side. Axial items (for voice, trunk and gait) were not significantly improved. PTT achieved 100% suppression of on-medication dyskinesias as well as reduction in pain (p < 0.001), dystonia (p < 0.001) and REM sleep disorders (p < 0.01). Reduction of the mean L-Dopa intake was 55%. Patients reported an 88% mean tremor relief and 82% mean global symptom relief on the operated side and 69% mean global symptom improvement for the whole body. There was no significant change of cognitive functions. The small group of bilateral PTTs at 1 year follow-up shows similar results as compared to unilateral PTTs but does not allow to draw firm conclusions at this point. Conclusion: MRgFUS PTT was shown to be a safe and effective intervention for PD patients, addressing all symptoms, with varying effectiveness. We discuss the need to integrate the preoperative state of the thalamocortical network as well as the psycho-emotional dimension. Frontiers Media S.A. 2020-01-14 /pmc/articles/PMC6971056/ /pubmed/31993437 http://dx.doi.org/10.3389/fsurg.2019.00076 Text en Copyright © 2020 Gallay, Moser, Rossi, Magara, Strasser, Bühler, Kowalski, Pourtehrani, Dragalina, Federau and Jeanmonod. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Gallay, Marc N.
Moser, David
Rossi, Franziska
Magara, Anouk E.
Strasser, Maja
Bühler, Robert
Kowalski, Milek
Pourtehrani, Payam
Dragalina, Christian
Federau, Christian
Jeanmonod, Daniel
MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience
title MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience
title_full MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience
title_fullStr MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience
title_full_unstemmed MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience
title_short MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience
title_sort mrgfus pallidothalamic tractotomy for chronic therapy-resistant parkinson's disease in 51 consecutive patients: single center experience
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971056/
https://www.ncbi.nlm.nih.gov/pubmed/31993437
http://dx.doi.org/10.3389/fsurg.2019.00076
work_keys_str_mv AT gallaymarcn mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT moserdavid mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT rossifranziska mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT magaraanouke mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT strassermaja mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT buhlerrobert mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT kowalskimilek mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT pourtehranipayam mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT dragalinachristian mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT federauchristian mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience
AT jeanmonoddaniel mrgfuspallidothalamictractotomyforchronictherapyresistantparkinsonsdiseasein51consecutivepatientssinglecenterexperience